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Rezk-Hanna M, Adolfo A, Warda US, Brecht ML, Benowitz NL. Association of non-daily hookah tobacco smoking and cardiovascular disease-related exposure biomarkers among U.S. users: The Population Assessment of Tobacco and Health Study. Prev Med Rep 2023; 36:102417. [PMID: 37753385 PMCID: PMC10518337 DOI: 10.1016/j.pmedr.2023.102417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Hookah smoking has grown to become a global tobacco epidemic. While cigarette smoking is a well-established cardiovascular disease (CVD) risk factor, the CVD risks of hookah smoking are unknown, particularly among regular U.S. adult hookah users who are predominantly non-daily users. Herein, we examined the association between hookah smoking and biomarkers of CVD risk among regular exclusive hookah smokers (n = 75), compared to regular exclusive cigarette smokers (n = 1773), dual hookah and cigarette smokers (n = 43) and never tobacco users (n = 757), using data from a nationally representative sample of adults from the Population Assessment of Tobacco and Health Study (2013-2014). Whereas 84% of cigarette smokers reported daily use, only 8% of hookah smokers reported daily use, with more than a third reporting monthly use. Adjusting for age and sex and as compared to exclusive cigarette smokers, exclusive hookah smokers had significantly lower geometric mean concentrations in serum sICAM-1 and urinary F2-isoprostane (p < 0.05). Although not statistically significant, a signal of increased oxidative stress was observed among hookah smokers as compared to never tobacco users (urinary F2-isoprostane). CVD-related harm biomarkers appear to be lower among hookah smokers than cigarette smokers. These findings represent patterns of hookah smoking predominantly shared among adult U.S. users who report non-daily occasional use and do not reflect solitary, daily use as is common in the Middle East. Future studies with longer exposure and longitudinal hookah use are warranted to explore the association between hookah smoking and CVD risk.
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Affiliation(s)
- Mary Rezk-Hanna
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
| | - Amanda Adolfo
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
| | - Umme Shefa Warda
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
| | - Mary-Lynn Brecht
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
| | - Neal L. Benowitz
- Divsion of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Manla Y, Almahmeed W. The Pandemic of Coronary Heart Disease in the Middle East and North Africa: What Clinicians Need to Know. Curr Atheroscler Rep 2023; 25:543-557. [PMID: 37615785 PMCID: PMC10471667 DOI: 10.1007/s11883-023-01126-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE OF REVIEW Coronary heart disease (CHD) is the leading cause of morbidity, mortality, and disability in the Middle East and North Africa (MENA). While the prevention, diagnosis, and management of CHD have been detailed in international guidelines, we aimed in this review to quantify the pandemic of CHD in the MENA region and highlight regional patient characteristics, clinical challenges, and future directions to optimize CHD care in the region. RECENT FINDINGS Patients with CHD in the MENA feature younger age at presentation and worse prognosis in women. Despite the high burden of CHD risk factors, many of these factors remain underrecognized, undertreated, and uncontrolled. Additionally, CHD care is hampered by poor patient awareness, inefficient preventive strategies, and limited access to guideline-recommended therapeutics. All stakeholders involved in healthcare should work together to develop and execute strategies aimed at tackling the burden of CHD in the MENA.
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Affiliation(s)
- Yosef Manla
- Department of Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Wael Almahmeed
- Department of Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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AlMulla A, Kouyoumjian S, Maisonneuve P, Cheema S, Mamtani R. Waterpipe smoking: Results from a population-based study in
Qatar. Tob Induc Dis 2022; 20:61. [PMID: 35836909 PMCID: PMC9227603 DOI: 10.18332/tid/149907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/06/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Waterpipe smoking is common in the Eastern Mediterranean Region and is becoming more prevalent in Qatar. To better plan waterpipe smoking control strategies we aimed to: 1) determine the prevalence of waterpipe smoking and explore its patterns in Qatar; 2) describe the knowledge, attitudes, and practices related to smoking behaviors; 3) recognize locations of waterpipe smoking and symptoms experienced during waterpipe sessions; and 4) evaluate the frequency of waterpipe smoking and the initiation age. METHODS We analyzed the data of a 7921 population-based survey of adults aged ≥18 years (nationals and expatriates), conducted in Qatar between March and December 2019. Out of 7105 surveys collected, 6904 were complete and included in the analysis. RESULTS Of the 6904, 570 (8.3%; 95% CI: 7.7–9.0) were waterpipe tobacco smokers, 425 (10.6%) males and 145 (5.1%) females. The highest prevalence of waterpipe smoking was reported among people aged 18–24 years (10.6%). Of the 575 waterpipe smokers, 56.3% (n=324) were exclusive waterpipe smokers. Use of other tobacco products among waterpipe smokers was higher among Qataris (52.3%) than expatriates (37.7%). Waterpipe cafés were the most common location for waterpipe smoking, however, females preferred restaurants; 83.3% reported that waterpipe smoking is harmful, while 39.3% considered that it is less harmful than cigarette smoking. CONCLUSIONS Waterpipe smoking prevalence is considerably high in Qatar, the second form of tobacco used. The formulation of new policies and enforcement of regulatory restrictions on waterpipe smoking are essential to reduce its uptake. Expansion in tobacco cessation services for women and poly-tobacco users is needed.
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Affiliation(s)
- Ahmad AlMulla
- Tobacco Control Center, WHO Collaborating Center for Treating Tobacco Dependence, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Silva Kouyoumjian
- Tobacco Control Center, WHO Collaborating Center for Treating Tobacco Dependence, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Patrick Maisonneuve
- Unit of Clinical Epidemiology, Division of Epidemiology and Biostatistics, European Institute of Oncology, Scientific Institute for Research, Hospitalization and Healthcare, Milan, Italy
| | - Sohaila Cheema
- Institute for Population Health, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ravinder Mamtani
- Institute for Population Health, Weill Cornell Medicine-Qatar, Doha, Qatar
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Hallit S, Obeid S, Sacre H, Salameh P. Lebanese Waterpipe Dependence Scale (LWDS-11) validation in a sample of Lebanese adolescents. BMC Public Health 2021; 21:1627. [PMID: 34488694 PMCID: PMC8422680 DOI: 10.1186/s12889-021-11662-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 08/25/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Salameh et al. developed the Lebanese Waterpipe Dependence Scale (LWDS-11) that assesses nicotine dependence among adult waterpipe smokers. In view of the high waterpipe use among Lebanese youth and other neighboring countries, it was deemed necessary to check the psychometric properties of the LWDS-11, originally adapted to the Lebanese population, to measure nicotine dependence among adolescents. METHODS Two cross-sectional investigations were conducted; Study 1 (January and May 2019) enrolled a total of 449 students who were exclusive waterpipe smokers; this sample was used to conduct the exploratory factor analysis. Study 2 enrolled another sample composed of 243 waterpipe smoking adolescents. This sample was independent from the first one and was used to conduct the confirmatory analysis. RESULTS The results also showed that 312 (69.5%) [95% CI 0.652-0.738] had high waterpipe dependence (scores of ≥10). Results of the factor analysis in sample 1 showed that all LWDS-11 items were extracted following the factor analysis. Items converged over a solution of one factor; total variance explained = 70.45%, αCronbach = 0.96). The results of the confirmatory factor analysis were as follows: the Maximum Likelihood Chi-Square = 129.58 and Degrees of Freedom = 45, which gave a χ2/df = 2.88. For non-centrality fit indices, the Steiger-Lind Root Mean Square Error of Approximation (RMSEA) was 0.08 [0.071-0.106]. Moreover, the Comparative Fit Index (CFI) value was 0.77. CONCLUSION The preliminary results suggest that the LWDS-11 has good psychometric properties to measure waterpipe dependence among adolescents. We hope this tool would serve the benefit of research and epidemiology.
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Affiliation(s)
- Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
| | - Sahar Obeid
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
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Alomari A, Alananzeh I, Lord H, Fernandez R. The Adherence to Healthy Lifestyle Among Arab Patients With Cardiovascular Disease: Mixed-Method Review. J Transcult Nurs 2021; 33:33-40. [PMID: 34318717 DOI: 10.1177/10436596211035176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) accounts for 25% to 45% of deaths among Arab people. The purpose of this review was to investigate the level, predictors, motivators, and barriers to adherence to lifestyle recommendations among Arab patients with CVD. METHOD A systematic search of the literature was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMCARE, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials were searched. Studies that explored adherence to a healthy lifestyle among Arab adult patients with CVD were included. RESULTS Twelve studies were included. Quantitative results showed low adherence among Arab people with CVD. Qualitative synthesized results revealed that internal motivators, personal desire as well as structural drivers impact the patient's ability to adhere to a healthy lifestyle. DISCUSSION Multidimensional solutions that consider religion and culture and include active involvement of families are required to improve adherence.
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Affiliation(s)
- Albara Alomari
- Western Sydney University, Penrith, New South Wales, Australia
| | | | - Heidi Lord
- South Eastern Sydney Local Health District, Kogarah, New South Wales, Australia
| | - Ritin Fernandez
- University of Wollongong, Liverpool, New South Wales, Australia
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Chaieb F, Ben Saad H. The Chronic Effects of Narghile Use on Males' Cardiovascular Response During Exercise: A Systematic Review. Am J Mens Health 2021; 15:1557988321997706. [PMID: 33729068 PMCID: PMC7975579 DOI: 10.1177/1557988321997706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Narghile use has regained popularity throughout the world. Public opinion misjudges its chronic harmful effects on health, especially on the cardiovascular system. This systematic review aimed to evaluate the chronic effects of narghile use on cardiovascular response during exercise. It followed the preferred reporting items for systematic reviews guidelines. Original articles from PubMed and Scopus published until January 31, 2020, written in English, and tackling the chronic effects of narghile use on human cardiovascular response during exercise were considered. Five studies met the inclusion criteria. Only males were included in these studies. They were published between 2014 and 2017 by teams from Tunisia (n = 4) and Jordan (n = 1). One study applied the 6-min walk test, and four studies opted for the cardiopulmonary exercise test. Narghile use was associated with reduced submaximal (e.g., lower 6-min walk distance) and maximal aerobic capacities (e.g., lower maximal oxygen uptake) with abnormal cardiovascular status at rest (e.g., increase in heart rate and blood pressures), at the end of the exercise (e.g., lower heart rate, tendency to chronotropic insufficiency) and during the recovery period (e.g., lower recovery index). To conclude, chronic narghile use has negative effects on cardiovascular response to exercise with reduced submaximal and maximal exercise capacities.
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Affiliation(s)
- Faten Chaieb
- University of Sousse, Faculty of
Medicine of Sousse, Laboratory of Physiology, Sousse, Tunisia,Department of Physiology and Functional
Exploration, Farhat Hached University Hospital of Sousse, Tunisia
| | - Helmi Ben Saad
- University of Sousse, Faculty of
Medicine of Sousse, Laboratory of Physiology, Sousse, Tunisia,Heart Failure Research Laboratory
(LR12SP09), Farhat Hached Hospital, Sousse, Tunisia,Helmi Ben Saad (MD, PhD), Laboratory of
Physiology, Faculty of Medicine of Sousse, University of Sousse, Street Mohamed
Karoui, Sousse 4000, Tunisia.
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Bhatnagar A, Maziak W, Eissenberg T, Ward KD, Thurston G, King BA, Sutfin EL, Cobb CO, Griffiths M, Goldstein LB, Rezk-Hanna M. Water Pipe (Hookah) Smoking and Cardiovascular Disease Risk: A Scientific Statement From the American Heart Association. Circulation 2020; 139:e917-e936. [PMID: 30845826 DOI: 10.1161/cir.0000000000000671] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tobacco smoking with a water pipe or hookah is increasing globally. There are millions of water pipe tobacco smokers worldwide, and in the United States, water pipe use is more common among youth and young adults than among adults. The spread of water pipe tobacco smoking has been abetted by the marketing of flavored tobacco, a social media environment that promotes water pipe smoking, and misperceptions about the addictive potential and potential adverse health effects of this form of tobacco use. There is growing evidence that water pipe tobacco smoking affects heart rate, blood pressure regulation, baroreflex sensitivity, tissue oxygenation, and vascular function over the short term. Long-term water pipe use is associated with increased risk of coronary artery disease. Several harmful or potentially harmful substances present in cigarette smoke are also present in water pipe smoke, often at levels exceeding those found in cigarette smoke. Water pipe tobacco smokers have a higher risk of initiation of cigarette smoking than never smokers. Future studies that focus on the long-term adverse health effects of intermittent water pipe tobacco use are critical to strengthen the evidence base and to inform the regulation of water pipe products and use. The objectives of this statement are to describe the design and operation of water pipes and their use patterns, to identify harmful and potentially harmful constituents in water pipe smoke, to document the cardiovascular risks of water pipe use, to review current approaches to water pipe smoking cessation, and to offer guidance to healthcare providers for the identification and treatment of individuals who smoke tobacco using water pipes.
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8
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Hallit S, Sacre H, Salameh P. Effect of waterpipe dependence on risk motives, attitudes and other health-related risky behaviors in Lebanese university students. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:4390-4403. [PMID: 31832948 DOI: 10.1007/s11356-019-06961-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Abstract
Explore whether waterpipe dependence in young Lebanese adults would have any effect on modifying the association between risk conception, attitude, and other risky behaviors. A cross-sectional study was carried out using a proportionate cluster sample of Lebanese university students (3384 students). Waterpipe dependence was associated with higher association of alcohol dependence and cigarette dependence by 76.7% and higher excitement for dangerous behaviors by 7.1%. It was significantly associated with increased association of cigarette dependence and alcohol dependence by 66.8%, with the thinking of a behavior of being not dangerous by 239%, with having motives for risky behaviors by 74.1%, with ever having unsafe sex by 111.74%, and between having motives for risky behaviors and ever having unsafe sex by 61.95%. Waterpipe dependence was associated with higher motives, excitement, and perception of risk and risky behaviors, namely cigarette dependence, alcohol dependence, and unsafe sex. Moreover, it was associated with higher risky behavior interdependence.
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Affiliation(s)
- Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.
| | - Hala Sacre
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
- Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Pascale Salameh
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
- Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
- Faculty of Medicine, Lebanese University, Hadat, Lebanon
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Hallit S, Layoun N, Malaeb D, Outayek M, Boueid MJ, Waked M, Bacha ZA, Salameh P. The impact of textual and pictorial warnings on tumbac (waterpipe tobacco) boxes on the motivation and intention to quit waterpipe smoking in Lebanon: a cross-sectional study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:36647-36657. [PMID: 31734838 DOI: 10.1007/s11356-019-06801-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
Few published studies have examined the impact of waterpipe tobacco pictorial health warnings worldwide but none of these papers assessed the motivation and intention to quit among Lebanese waterpipe smokers. To examine factors associated with the motivation and intention to quit waterpipe smoking (WS) in Lebanon, particularly the impact of textual vs. pictorial warnings on tumbac boxes. A cross-sectional study was conducted between January and May 2018, involving 520 participants. Having smokers at work (OR = 0.92) and increasing number of waterpipes per week (ORa = 0.94) were associated with decreased motivation to quit WS. Thinking that shocking images on tumbac packages would have more effect than textual warnings (ORa = 2.96) and those who would change the tumbac if the company decides to change the look of the box with shocking images about health damage (ORa = 1.98) were significantly associated with increased motivation to quit WS. Having a high motivation (ORa = 2.61), thinking that using shocking images on tumbac boxes can have more effect than textual warnings (ORa = 2.12), those who stopped smoking because of the warnings (ORa = 2.62), those who would choose pictorial warnings alone (ORa = 2.11), and both pictorial and textual warnings (ORa = 3.41) on tumbac packages were associated with higher intention to quit WS in two months. Pictorial and textual warnings on tumbac packs were associated with higher intention and motivation to stop WS. Public health education programs for this purpose seem warranted.
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Affiliation(s)
- Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.
| | - Nelly Layoun
- Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Diana Malaeb
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- Department of Life Sciences and Health, Paris-Est University, Paris, France
| | - Miguella Outayek
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Marie-Josée Boueid
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Mirna Waked
- Department of Pulmonology, St George Hospital University Medical Center, Beirut, Lebanon
- Faculty of Medicine, Balamand University, Koura, Lebanon
| | - Zeina Aoun Bacha
- Department of Pulmonary and Critical Care Medicine, Hotel-Dieu de France, Beirut, Lebanon
| | - Pascale Salameh
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
- Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
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Alamoudi BM, Ibrahim NK, Kalo BBM. Are proton pump inhibitors among the risk factors for acute coronary syndrome? A multi-centric case-control study between patients attending governmental hospitals in western Saudi Arabia. Saudi Med J 2019; 40:1098-1104. [PMID: 31707405 PMCID: PMC6901763 DOI: 10.15537/smj.2019.11.24602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To identify the predictors of acute coronary syndrome (ACS) and to determine the relationship between usage of proton pump inhibitors (PPIs) and the occurrence of a first non-fatal ACS event among patients that attended governmental hospitals in Jeddah, Saudi Arabia. Methods: A matched, multi-centric case-control study was performed between January and June of 2015 in Jeddah involving 2 governmental hospitals and the main university hospital. A total of 118 cases aged ≥18 years who were recently diagnosed with ACS were selected. For each case, one control matched by age and gender was selected. Information from an interview questionnaire and from reviewing patients’ medical records was recorded on a standardized data collection sheet. Results: Risk factors for ACS and the relationship between usage of PPIs and the occurrence of a first non-fatal ACS event were measured in 236 cases and matched controls. Current smoking (OR: 4.5; 95% CI: 1.92-10.98), excessive body weight (OR: 2.99; 95% CI: 1.38-6.45), and dyslipidemia (OR: 2.51; 95% CI: 1.07-5.84) were the predictors of ACS. Hypertension, diabetes, and moderate-to-high physical activity were associated with ACS. However, there was no statistical association between use of PPIs and occurrence of the first non-fatal ACS event (p>0.05). Conclusions: There was no association between PPIs and the occurrence of a first non-fatal ACS event. Smoking, increased weight, and dyslipidemia are considered predictors of ACS. Furthermore, ACS is associated with self-reported diabetes, hypertension, and physical activity.
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Affiliation(s)
- Banan M Alamoudi
- Department of Community Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Waziry R, Jawad M, Ballout RA, Al Akel M, Akl EA. The effects of waterpipe tobacco smoking on health outcomes: an updated systematic review and meta-analysis. Int J Epidemiol 2018; 46:32-43. [PMID: 27075769 DOI: 10.1093/ije/dyw021] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 12/25/2022] Open
Abstract
Background and aims A systematic review conducted in 2008 found significant associations between waterpipe tobacco smoking and lung cancer, respiratory disease, periodontal disease and low birthweight. Since then, a number of relevant studies have been published. The objective of this study was to update the systematic review on the effects of waterpipe tobacco smoking on health outcomes. Methods In May 2015 we electronically searched the following databases with no date restrictions: MEDLINE, EMBASE and the ISI Web of Science using a detailed search strategy with no language restrictions. We also screened the references' lists of the included studies. We included cohort, case-control and cross-sectional studies, and excluded case reports, conference abstracts, editorials and reviews. We excluded studies not conducted in humans, assessing physiological outcomes, not distinguishing waterpipe tobacco smoking from other forms of smoking or not reporting association measures. We assessed risk of bias for each included study and conducted meta-analyses for each of the outcomes of interest. Results We identified 50 eligible studies. We found that waterpipe tobacco smoking was significantly associated with: respiratory diseases [COPD; odds ratio (OR) = 3.18, 95% confidence interval CI = 1.25, 8.08; bronchitis OR = 2.37, 95% CI = 1.49, 3.77; passive waterpipe smoking and wheeze OR) = 1.97, 95% CI = 1.28, 3.04]; oral cancer OR = 4.17, 95% CI = 2.53, 6.89; lung cancer OR = 2.12, 95% CI = 1.32, 3.42; low birthweight (OR = 2.39, 95% CI = 1.32, 4.32); metabolic syndrome (OR 1.63-1.95, 95% CI = 1.25, 2.45); cardiovascular disease (OR = 1.67, 95% CI = 1.25, 2.24); and mental health (OR 1.30-2.4, 95% CI = 1.20, 2.80). Waterpipe tobacco smoking was not significantly associated with: oesophageal cancer (OR = 4.14, 95% CI = 0.93, 18.46); worse quality of life scores [standardized mean difference (SMD) = -0.16, 95% CI = -0.66, 0.34]; gastric carcinoma (OR = 2.16, 95% CI = 0.72, 6.47); bladder cancer (OR = 1.25, 95% CI = 0.99, 1.57); prostate cancer (OR = 7.00, 95% CI = 0.90, 56.90); hepatitis C infection (OR = 0.98, 95%0.80, 1.21); periodontal disease (OR = 3.00, 5.00); gastro-oesophageal reflux disease (OR = 1.25, 95% CI = 1.01, 1.56); nasopharyngeal carcinoma (OR = 0.49, 95% CI = 0.20, 1.23); bladder cancer (OR = 1.25, 95% CI = 0.99, 1.57); infertility (OR = 2.50, 95% CI = 1.00, 6.30); and mortality (OR = 1.15, 95% CI = 0.93, 1.43). Conclusions There is accumulating evidence about the association of waterpipe tobacco smoking with a growing number of health outcomes.
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Affiliation(s)
- Reem Waziry
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, London, UK.,Academic Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Rami A Ballout
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohammad Al Akel
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.,Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
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Alhaddad IA, Tabbalat R, Khader Y, Al-Mousa E, Izraiq M, Nammas A, Jarrah M, Saleh A, Hammoudeh A. Outcomes of Middle Eastern Patients Undergoing Percutaneous Coronary Intervention: The Primary Analysis of the First Jordanian PCI Registry. Heart Views 2017; 18:3-7. [PMID: 28584584 PMCID: PMC5448249 DOI: 10.4103/1995-705x.206206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Aim: This is a prospective multicenter registry designed to evaluate the incidence of adverse cardiovascular events in Middle Eastern patients undergoing percutaneous coronary interventions (PCI). The registry was also designed to determine the predictors of poor outcomes in such patients. Methods and Results: We enrolled 2426 consecutive patients who underwent PCI at 12 tertiary care centers in Jordan between January 2013 and February 2014. A case report form was used to record data prospectively at hospital admission, discharge, and 12 months of follow-up. Mean age was 56 ± 11 years, females comprised 21% of the study patients, 62% had hypertension, 53% were diabetics, and 57% were cigarette smokers. Most patients (77%) underwent PCI for acute coronary syndrome. In-hospital and 1-year mortality rates were 0.78% and 1.94%, respectively. Definite or probable stent thrombosis occurred in 9 patients (0.37%) during hospitalization and in 47 (1.94%) at 1 year. Rates of target vessel repeat PCI and coronary artery bypass graft surgery at 1 year were 3.4% and 0.6%, respectively. The multivariate analysis revealed that cardiogenic shock, congestive heart failure, ST-segment deviation, diabetes, and major bleeding were significantly associated with higher risk of 1-year mortality. Conclusions: In this first large Jordanian registry of Middle Eastern patients undergoing PCI, patients treated were relatively young age population with low in-hospital and 1-year adverse cardiovascular events. Certain clinical features were associated with worse outcomes and may warrant aggressive therapeutic strategies.
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Affiliation(s)
- Imad A Alhaddad
- Department of Cardiovascular, Jordan Hospital, Amman, Jordan
| | - Ramzi Tabbalat
- Department of Cardiology, Khalidi Medical Center, Amman, Jordan
| | - Yousef Khader
- School of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Eyas Al-Mousa
- Department of Cardiology, Istishari Hospital, Amman, Jordan
| | - Mahmoud Izraiq
- Department of Cardiology, Specialty Hospital, Amman, Jordan
| | - Assem Nammas
- Department of Cardiology, Ibn Al-Haytham Hospital, Amman, Jordan
| | - Mohammad Jarrah
- Department of Internal Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan
| | - Akram Saleh
- Department of Internal Medicine, Jordan University of Jordan School of Medicine, Amman, Jordan
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Jaam M, Al-Marridi W, Fares H, Izham M, Kheir N, Awaisu A. Perception and intentions to quit among waterpipe smokers in Qatar: a cross-sectional survey. Public Health Action 2016; 6:38-43. [PMID: 27051611 DOI: 10.5588/pha.15.0054] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 11/25/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the perceptions and attitudes of waterpipe (shisha) smokers in Qatar regarding the health risks associated with addiction and to determine their intentions to quit. METHODS A cross-sectional survey was conducted among 181 self-reported waterpipe smokers. Participants were approached in public places as well as in shisha cafes in Qatar. The questionnaire included items related to perception, attitude and intention to quit. Both descriptive and inferential statistics were performed for data analyses, with P ≤ 0.05 considered statistically significant. RESULTS About 44% of the respondents believed that waterpipe smoking was safer than cigarette smoking, and more than 70% would not mind if their children became involved in waterpipe smoking. More than half of the current smokers wanted to quit smoking shisha at some point, and 17% identified health concerns as the main motivating factor for their intention to quit. CONCLUSION A large proportion of shisha smokers viewed shisha as a safer alternative to cigarettes, yet they admitted to intending to quit. These findings underscore the need to design educational interventions and awareness campaigns as well as impose stringent laws on waterpipe smoking in public places in Qatar.
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Affiliation(s)
- M Jaam
- College of Pharmacy, Qatar University, Doha, Qatar
| | - W Al-Marridi
- College of Pharmacy, Qatar University, Doha, Qatar
| | - H Fares
- College of Pharmacy, Qatar University, Doha, Qatar
| | - M Izham
- College of Pharmacy, Qatar University, Doha, Qatar
| | - N Kheir
- College of Pharmacy, Qatar University, Doha, Qatar
| | - A Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar
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Zubaid M, Ahmed Albinali H, Almahmeed W. The Gulf Heart Association: a professional association supporting research and collaboration in the Middle East. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Vupputuri S, Hajat C, Al-Houqani M, Osman O, Sreedharan J, Ali R, Crookes AE, Zhou S, Sherman SE, Weitzman M. Midwakh/dokha tobacco use in the Middle East: much to learn. Tob Control 2014; 25:236-41. [PMID: 25342581 PMCID: PMC4789808 DOI: 10.1136/tobaccocontrol-2013-051530] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 08/27/2014] [Indexed: 01/30/2023]
Abstract
Many alternative tobacco products (ATPs), such as hookahs, have grown in popularity and use beyond their locale of origin and are therefore becoming a significant global public health concern. This article provides an overview of an under-reported and understudied ATP, dokha, which is smoked in a midwakh pipe. It describes the state of tobacco control in the Arabian Gulf region where midwakh smoking appears to be most common, the history of midwakh and dokha use, and what is known about midwakh smoking from the published literature. On the basis of the stark lack of data on midwakh use, we suggest priority areas to focus future research. Preliminary data and observations from health providers and the public health sector suggest that midwakh smoking may pose challenges to the tobacco control efforts in the Arabian Gulf region. If it is emerging as a new ATP outside this region, there could be a significant impact on tobacco control strategies globally.
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Affiliation(s)
- S Vupputuri
- Kaiser Permanente Georgia, The Center for Health Research, Atlanta, Georgia, USA
| | - C Hajat
- United Arab Emirates University, College of Medicine and Health Sciences, Institute of Public Health, Al Ain, UAE
| | - M Al-Houqani
- United Arab Emirates University, College of Medicine and Health Sciences, Institute of Public Health, Al Ain, UAE
| | - O Osman
- United Arab Emirates University, College of Medicine and Health Sciences, Institute of Public Health, Al Ain, UAE
| | - J Sreedharan
- Gulf Medical University, Research Division, Ajman, UAE
| | - R Ali
- United Arab Emirates University, College of Medicine and Health Sciences, Institute of Public Health, Al Ain, UAE Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | - A E Crookes
- Heriot-Watt University, School of Life Sciences, Dubai, UAE
| | - S Zhou
- Department of Pediatrics and Environmental Medicine, New York University School of Medicine, New York, New York, USA
| | - S E Sherman
- New York University/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE Department of Population Health, Medicine and Psychiatry, New York University School of Medicine, New York, New York, USA
| | - M Weitzman
- Department of Pediatrics and Environmental Medicine, New York University School of Medicine, New York, New York, USA
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Salam AM, Gersh BJ, AlBinali HA, Singh R, Asaad N, Al-Qahtani A, Suwaidi JA. The prognostic implications of lack of palpitations in patients hospitalised with atrial fibrillation: observations from a 20-year registry. Int J Clin Pract 2014; 68:122-9. [PMID: 24341306 DOI: 10.1111/ijcp.12230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/06/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES It is well recognised that patients differ in the clinical presentation of atrial fibrillation (AF), ranging from the typical symptom of palpitations, atypical symptoms in others and a substantial that are asymptomatic. Whether the different patterns of presentation are associated with differences in outcomes is not known. The aim of this study was to evaluate the prevalence and the prognostic implications of lack of palpitations among patients hospitalised with AF in a large prospective registry. METHODS Retrospective analysis of all patients hospitalised with AF in Qatar from 1991 to 2010 was made. Patients were divided into two groups according to the presence or absence of palpitations on presentation. Clinical characteristics and outcome were analysed. RESULTS During the 20-year period, 3850 patients were hospitalised for AF; 1724 (44.8%) had palpitations on presentation while 2126 (55.2%) had no palpitations. Patients who lacked palpitations were 9 years older, had a higher prevalence of diabetes mellitus (64.7% vs. 35.3%), underlying coronary artery disease (CAD; 14.6% vs. 6.2%) and severe left ventricular dysfunction on echocardiography (25.5% vs. 6.6%), (all, p = 0.001). There were 141 deaths among the group with no palpitations compared with 19 among the group with palpitations (6.6% vs. 1.1%). Multivariate analysis of mortality predictors identified 'lack of palpitations' as an independent predictor of in-hospital mortality (relative risk 5.56; 95% confidence interval 1.20-25.0, p = 0.03). CONCLUSIONS Our study demonstrates for the first time that lack of palpitations as the presenting symptom of patients with AF is associated with worse in-hospital outcome independent of other risk factors or therapy. The underlying mechanisms and the role of confounders warrant further investigation.
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Affiliation(s)
- A M Salam
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
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Primack BA, Mah J, Shensa A, Rosen D, Yonas MA, Fine MJ. Associations between race, ethnicity, religion, and waterpipe tobacco smoking. J Ethn Subst Abuse 2014; 13:58-71. [PMID: 24564560 PMCID: PMC3998664 DOI: 10.1080/15332640.2013.850462] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We surveyed a random sample of 852 students at a large university in 2010-2011 to clarify associations between waterpipe tobacco smoking (WTS), ethnicity, and religion. Current (past 30 day) WTS was reported by 116 (14%) students, and 331 (39%) reported ever WTS. Middle Eastern ethnicity was associated with current WTS (odds ratio [OR] = 2.37; 95% confidence interval [CI] = 1.06, 5.34) and ever WTS (OR = 2.59; 95% CI = 1.22, 5.47). South Asian ethnicity was associated with lower odds for ever WTS (OR = 0.42; 95% CI = 0.21, 0.86), but there was no significant association between South Asian ethnicity and current WTS. Being an atheist and having lower religiosity were associated with both WTS outcomes.
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Affiliation(s)
- Brian A Primack
- a Division of General Internal Medicine and the Division of Adolescent Medicine, Department of Pediatrics , University of Pittsburgh School of Medicine, and the Program for Research on Media and Health, University of Pittsburgh , Pittsburgh , Pennsylvania
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Donnelly TT, Al Suwaidi J, Al Enazi NR, Idris Z, Albulushi AM, Yassin K, Rehman AM, Hassan AHA. Qatari women living with cardiovascular diseases-challenges and opportunities to engage in healthy lifestyles. Health Care Women Int 2013; 33:1114-34. [PMID: 23153347 DOI: 10.1080/07399332.2012.712172] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In Qatar, cardiovascular diseases are the leading causes of morbidity and mortality. Cardiovascular diseases can be prevented and controlled by modifying lifestyle risk behaviors. In this qualitative study, we investigate ways to increase participation in physical activity, and to promote a healthy diet, and nonsmoking behavior in Qatari women. Individual in-depth interviews were conducted with 50 Arabic women. Participation in physical activity, observing a healthy diet, and abstinence from smoking are desirable lifestyle practices among Qatari women. Social support networks, cultural values, religion, changing sociodemographic and economic conditions, heart disease, and a harsh climate affect the ability of these women to pursue a healthy lifestyle.
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Gehani AA, Al-Hinai AT, Zubaid M, Almahmeed W, Hasani MRM, Yusufali AH, Hassan MO, Lewis BS, Islam S, Rangarajan S, Yusuf S. Association of risk factors with acute myocardial infarction in Middle Eastern countries: the INTERHEART Middle East study. Eur J Prev Cardiol 2012; 21:400-10. [DOI: 10.1177/2047487312465525] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | | | | | - Wael Almahmeed
- Heart and Vascular Institute, Sheikh Khalifa Medical City, UAE
| | | | | | | | | | - Shofiqul Islam
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Canada
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Al Suwaidi J, Al Habib K, Asaad N, Singh R, Hersi A, Al Falaeh H, Al Saif S, Al-Motarreb A, Almahmeed W, Sulaiman K, Amin H, Al-Lawati J, Al-Sagheer NQ, Alsheikh-Ali AA, Salam AM. Immediate and one-year outcome of patients presenting with acute coronary syndrome complicated by stroke: findings from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2). BMC Cardiovasc Disord 2012; 12:64. [PMID: 22894647 PMCID: PMC3480946 DOI: 10.1186/1471-2261-12-64] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 08/09/2012] [Indexed: 11/18/2022] Open
Abstract
Background Stroke is a potential complication of acute coronary syndrome (ACS). The aim of this study was to identify the prevalence, risk factors predisposing to stroke, in-hospital and 1-year mortality among patients presenting with ACS in the Middle East. Methods For a period of 9 months in 2008 to 2009, 7,930 consecutive ACS patients were enrolled from 65 hospitals in 6 Middle East countries. Results The prevalence of in-hospital stroke following ACS was 0.70%. Most cases were ST segment elevation MI-related (STEMI) and ischemic stroke in nature. Patients with in-hospital stroke were 5 years older than patients without stroke and were more likely to have hypertension (66% vs. 47.6%, P = 0.001). There were no differences between the two groups in regards to gender, other cardiovascular risk factors, or prior cardiovascular disease. Patients with stroke were more likely to present with atypical symptoms, advanced Killip class and less likely to be treated with evidence-based therapies. Independent predictors of stroke were hypertension, advanced killip class, ACS type –STEMI and cardiogenic shock. Stroke was associated with increased risk of in-hospital (39.3% vs. 4.3%) and one-year mortality (52% vs. 12.3%). Conclusion There is low incidence of in-hospital stroke in Middle-Eastern patients presenting with ACS but with very high in-hospital and one-year mortality rates. Stroke patients were less likely to be appropriately treated with evidence-based therapy. Future work should be focused on reducing the risk and improving the outcome of this devastating complication.
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Affiliation(s)
- Jassim Al Suwaidi
- Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar.
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Almahmeed W, Arnaout MS, Chettaoui R, Ibrahim M, Kurdi MI, Taher MA, Mancia G. Coronary artery disease in Africa and the Middle East. Ther Clin Risk Manag 2012; 8:65-72. [PMID: 22368447 PMCID: PMC3284217 DOI: 10.2147/tcrm.s26414] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Countries in Africa and the Middle East bear a heavy burden from cardiovascular disease. The prevalence of coronary heart disease is promoted in turn by a high prevalence of cardiovascular risk factors, particularly smoking, hypertension, dyslipidemia, diabetes, and sedentary lifestyles. Patients in Africa and the Middle East present with myocardial infarction at a younger age, on average, compared with patients elsewhere. The projected future burden of mortality from coronary heart disease in Africa and the Middle East is set to outstrip that observed in other geographical regions. Recent detailed nationally representative epidemiological data are lacking for many countries, and high proportions of transient expatriate workers in countries such as Saudi Arabia and the United Arab Emirates complicate the construction of such datasets. However, the development of national registries in some countries is beginning to reveal the nature of coronary heart disease. Improving lifestyles (reducing calorie intake and increasing physical activity) in patients in the region will be essential, although cultural and environmental barriers will render this difficult. Appropriate prescribing of pharmacologic treatments is essential in the prevention and management of cardiovascular disease. In particular, recent controversies relating to the therapeutic profile of beta-blockers may have reduced their use. The current evidence base suggests that beta-blockers are as effective as other therapies in preventing cardiovascular disease and that concerns relating to their use in hypertension and cardiovascular disease have been overstated.
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Affiliation(s)
- Wael Almahmeed
- Heart and Vascular Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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